Nurse residency programs and new graduate nurse leadership development

NOVICE NURSE
Abstract
New graduate nurses play a critical role in the nursing profession. In essence, graduate nurse are the primary interaction between physicians and patients. As the nature and form of healthcare continues to transform and grow, graduate nurses will require enhanced knowledge and leadership skills to effectively perform their functions. As Blevins et al. (2018) points out, most of the new graduate nurses are not prepared for the fast-paced, high-acuity healthcare environments. As a result, the Institute of Medicine (2010) recommends that hospitals have nurse residency programs (NRPs) to support nurse graduates throughout transition to practice (Blevins, 2018). This is likely to boost new nurse confidence levels. Just like emotional intelligence, confidence is a learned trait. This paper evaluates how effective nurse residency programs are in helping new graduate nurses develop leadership skills. The nurse preceptor is a mentor who provides support to new graduate nurses and provides guidance when difficult situations arise. Amongst other things, this guidance from the preceptor further develops the new graduate’s organizational and prioritization skills when caring for patients. Some of the skills and competencies that would come in handy for new nurses include: communication skills, emotional intelligence, cultural competence, team building skills, and inter-professional collaboration capabilities. All of these skills are necessary to being a confident, effective, and inspiring nurse.





Background
About 75% of registered nurses (RNs) in the United States in the 50-64 age bracket are planning to retire by 2020. The need for nurses is expected to significantly increase over the next 10 years. Newly licensed nurses are leaving their first positions to work in different departments. While there is a high demand for nurses, the percentage of unfilled RN positions remains high at approximately 20%. At present, there are about 10% of registered nurses working in a hospital setting but having less than 1 year of experience. This percentage will most likely increase as experienced nurses are soon expected to retire. The cost of recruiting and training a new nurse is estimated to range between $62,100 and $67,000 (Cochran, 2017). In essence, many of these new graduate nurses are not prepared for the fast-paced, high-acuity healthcare environments. As a result, the Institute of Medicine (2010) recommends that hospitals have nurse residency programs (NRPs) to support nurse graduates into transition to practice (Blevins, 2018). In 2004, the first nurse residency program was started by the American Association of Colleges of Nursing (AACN) in the ICU setting.
NRPs are year-long commitments which train new nurses for a period of 12 months and seek to not only support the transition to practice, but also adaptation to the fast-paced healthcare environment. The NRPs use a variety of structures and timelines in orienting new graduate nurses, allowing them to pick the program that fits their specific needs in communication, organization, and critical thinking. Even though the program requires a year-long commitment from nurse residents, it allows enough time for new nurses to transition into their new position - which will serve to increase their confidence. The NRP has three structures used to train new nurses. These are: didactic-based, simulation-based, and clinical preceptorships. The new nurse is paired with a preceptor during their training. In basic terms, a clinical preceptor is a mentor who has the prerequisite experience and provides support and guidance to nurses through difficult and overwhelming times. Working with a preceptor in the unit allows the new nurse to get familiar and comfortable with the clinical setting. The orientation period with a preceptor is an important aspect of successful transition.
The guidance from the preceptor allows the new graduate to work on organizational and prioritization skills when caring for patients. One difficult part of transition is learning how to work independently and how to effectively care for an increased number of patients. Under the guidance of a nurse preceptor who has the relevant experience and skills as a result of working in diverse settings, new graduates can learn strategies to help them optimize their prioritization and team work skills. Orientation checklists ought to be completed by both the preceptor and the new graduate. This is of great relevance in seeking to highlight the skills a nurse needs to work on. Each program has different benefits, despite all programs having the sole purpose of creating the new nurse's foundation in communication, critical thinking, and stress management (Walsh, 2018). It is important to note that new graduate nurses ought to have leadership skills to become competent nurses. These skills are inclusive of: the ability to communicate effectively, emotional intelligence, cultural competence, team building skills, and the ability to collaborate with inter-professionals. Over time, NRPs have played a critical role in preparing new nurse graduates to develop the said leadership skills. As Blevins (2016) points out, these programs have led to improvements in safety, decision making, and have further enhanced job satisfaction among nurse graduates.
Communication
New graduate nurses need strong communication skills to be able to handle difficult conversations with staff, patients, healthcare providers, and families. In addition, new nurses need to have effective communication skills so as to be able to collaborate with all the key stakeholders in the treatment process, i.e. the healthcare team, families of patients, and patients themselves. Thanks to superior communication skills, new graduates can grow to become confident and independent nurses, and be able to provide excellent care for patients (Walsh, 2018). To be experts, new graduate nurses require skills and knowledge that are learned through leadership development classes. Being an achiever is getting the desired results. For new graduates to be critical thinkers, they must not only have the relevant knowledge, but they also ought to have planning and learning skills (Henriken, 2016). Good communication skills motivate nurses to work and enhance performance - all of which come in handy in ensuring job success. Nurses who communicate well with staff members are capable of stimulating better work efforts. To be effective leaders, new nurses need to learn how to communicate with a diverse population. Organizations should evaluate nurse leaders’ communication skills to make sure they are effective communicators. Towards this end, new nurses can take classes to improve their communication skills.
In essence, new nurses who have excellent communication skills in a culturally diverse setting prompt the creation of better working environments. As the workplace becomes even more diverse, graduate nurses have to adapt their communication strategies so as to work more effectively with a diverse group of nurses. The end result in this case would be the further enhancement of nurse leaders’ communication proficiency – which in the end leads to the development of strong nurse-nurse leader relationships. It is important to note that some of the qualities that further promote a new nurse’s leadership skills are inclusive of: being able to prioritize, having a strong work ethic, honesty, loyalty, good judgment, and emotional intelligence (EI) (Fowler, 2018).
Emotion Intelligence
An emotionally intelligent person is an individual who properly understands his own emotions or other people’s emotions properly. Thus, emotional intelligence (EI) is the ability to understand emotions, use emotions to enhance thinking, and manage emotions effectively with others. EI is important for perceptive thinking and managing stressful situations. New nurses who are sensitive to their emotions and those of others are likely to be effective leaders. Towards this end, new nurses should be aware of their own emotions, show empathy, and be able to identify their feelings. When a leader is sensitive of his or her emotions and those of others, this tends to have a positive impact on group decisions. Emotional intelligence is a key concept in the management area. For new nurse to be effective leaders, they should have emotional intelligence so as to be able to understand other employees’ feeling and emotions. Managers with low emotional intelligence could create an atmosphere of fear and anxiety in the organization which negatively impacts workplace performance.
It is important to note that nurse managers are responsible for the provision of excellent nursing care. A manager’s personal characteristics and the capability to understand their emotions could negatively impact their employees, and thus leadership performance. Emotional intelligence is a predictor of leadership and management success. Employees who can successfully manage their emotions have been shown to work more effectively than those who lack this key skill (Bikmoradi1 et al., 2018). According to Olawoyi (2018), a motivated individual is capable of emotional control and effective change management.
Cultural Competence
Cultural competence is being able to develop an awareness of one’s own existence, sensations, and thoughts without letting this influence those from other backgrounds. New graduate nurses must be able to demonstrate knowledge, understand the patient’s culture, accept and respect cultural differences, and adapt to the patient’s culture. Cultural competence has gained national attention as a way of reducing cultural disparities in healthcare. Cultural competency training seeks to improve the cultural competence of healthcare providers and thus address health disparities. The ability to provide culturally competent care is important in healthcare environments. New graduate nurses must develop cultural competency to be effective in establishing trust with patients and develop nursing interventions designed to meet patient’s needs. In today’s society, culturally competent care is not provided to all patients because not many nurses have a clear understanding of diverse cultural backgrounds. It is important for healthcare professionals to assess cultural competence that involve direct patient care because this helps them to determine individual strengths and weaknesses, which in turn helps in care planning. Many healthcare and related service settings such as social works, counseling, and occupational therapy have incorporated cultural competence.
Culturally competent practice is founded on a three-dimensional model. The first component is cultural awareness, which could be defined as the ability to understand one’s own cultural and professional background. The Cultural Awareness Assessment Tool is used to assess a person’s cultural awareness. It should be noted that lack of cultural awareness and not being able to provide culturally competent care can result in inadequate care. The second component, i.e. cultural knowledge, is seeking and getting information on different cultures. New nurses can expand their cultural knowledge by getting information that is offered in journal articles, seminars, and workshop presentations. Cultural skill, the third component, is the ability of a nurse to collect cultural data regarding the client’s presenting problem and perform a physical assessment. On this front, nurses should listen and develop keen interest on what is being presented, and also be non-judgmental about what they hear. Cultural encounter is the fourth component. It encourages nurses to interact with patients from culturally diverse backgrounds. New nurses who interact with patients from different cultural backgrounds help increase their own cultural competence. Lastly, cultural desire is the nurse’s motivation to want to be aware and seek cultural encounters. New nurses will mostly learn to respect and accept cultural differences, to be open to others, and to learn from others. Based on these components, there is a direct relationship between a patient’s culture and his or her health. Of the many variables, culture is one of the most influential. It is important to note that the new nurses have the skill and expertise to be able to provide culturally competent nursing care (Campinha-Bacote, 2018).
Team Building
In healthcare, team building is when all team members believe, understand, and work towards a shared purpose to care for patients. A workplace with a diverse workforce that cuts across all ages must promote teamwork as a way of delivering effective healthcare and meeting patient outcomes. Leadership is needed in order to build a strong a team. Leadership has clear goals, objectives, and is founded on trust. Ideally, team leaders are able to motivate others and have good listening skills. It is important to note that leaders need to have patience and honesty to create a successful team. All teams work through different stages of development, but are more efficient when openness and trust are fostered. Nurse leaders focus on teamwork in the work environment to reduce medical errors and improve patient safety. Healthcare environments promote team-building because the said team-building improves problem solving which leads to healthier work environments. Therefore, nurse leaders should guide new nurses in promoting teamwork. Successful teams have increased ability to communicate, create an inclusive environment, create trusting relationships, and learn to resolve conflicts. Team leaders provide measureable objectives to help guide team members in critical skills such as communication and relationship building. Effective teams also work together to develop an understanding of one another’s communication preferences. This is done via open discussion and agreement.
Ultimately, inclusiveness allows team members to recognize what others have to offer and engage each member of the team. When building a team, individuals have to learn to develop trust and friendship. Over time, team members learn to accept one another and eventually develop a rapport where there is trust. Developing trust allows team members to admit errors, voice their concerns, and discuss weakness without fear of being judged. In addition, team members will ask for assistance when needed and provide feedback. It is important for effective teams to establish open communication, trust, and promote inclusivity which leads to successful conflict resolution. Conflicts ought to be resolved or avoided in team settings. The most important strategy to embrace is a team agreement that creates a safe working environment for patients. Providing team-based communication workshops can build team unity. In addition, respecting one another and being mindful of the assertions of others could promote team cohesiveness. It is also important to remember that all team members want to feel that their contribution matters (Moore et al., 2016).
Inter-professional Collaboration
New graduate nurses need to learn how to collaborate with inter-professionals. Inter-professional teams incorporate many different professionals who have various educational backgrounds, training, and experience. They often have a common mandate. Professionals provide the best care to patients by interacting with other healthcare professionals – via effective communication so as to ensure better patient outcomes (Palanisamy et al., 2015). An effective way to improve interdisciplinary communication is through team rounding. There are many benefits of inter-professional team rounds. These include better communication and decreased adverse events. Team rounding not only improves communication, but it also allows other professionals to be involved in the decision making process (Adams et al., 2018). Practices that promote teamwork and collaboration improve patient safety (Cropley, 2015). Palanisamy et al. (2015) state that patients receive safe and reliable care when healthcare professionals work as a team and communicate effectively (Palanisamy et al., 2015). New nurses ought to work together with nurse supervisors and other team members to ensure patient safety (Cropley, 2015).
It is important to note that healthcare professionals cannot care for patients safely without access to correct and accurate information – effectively indicating the relevance of communication. Past studies have shown that healthcare professional communication is often ineffective due to differences in culture and the environment. Poor communication and collaboration with other healthcare professionals leads to an increase in medication errors, surgical mishaps, and patients care mistakes. As a matter of fact, many medical errors are caused by poor interpersonal communication and failure to appreciate each other’s point of view.
Having regular meetings with the interdisciplinary team could allow employees to share their skills, knowledge, and responsibility - while at the same time discussing or highlighting the most urgent or important concerns. Precise and accurate communication comes in handy in ensuring the safety of the patients. It is important to note that there is no single best way of communicating. However, some of the more common methods are email, telephone, or face to face engagements. These different methods of communication allow professionals to work together as a team and to collaborate. Communicating permits healthcare professionals to share their knowledge and share decisions so as to provide better patient care (Palanisamy et al., 2015).
Summary
In essence, nurse residency programs are important in seeking to enable new nurses build leadership skills. New nurses learn to become confident and to be effective leaders. New nurses will learn to be effective leaders by ensuring that a nursing unit is not only run in an efficient manner, but also functions as effectively as it possibly should. However, as it has been pointed out elsewhere in this text, the workplace environment in healthcare continues to evolve with new graduates entering the nursing profession. These changes could end up making the duties and responsibilities of new nurse even more complex. For this reason, the relevance of continuous competence development cannot be overstated. In their diverse roles, new nurses who want to take on leadership roles ought to ensure that the hospital environment in which they operate is functioning well. This calls for the forging of close working relationships with staff members with an aim of improving patient outcomes while at the same time keeping staff members motivated. It is clear from the discussion above that with the right guidance, new nurses can develop leadership skills via which they can effectively juggle staff issues with patient care concerns – with the end result being a healthy working environment and the further improvement of the services offered. Overall, as new nurses enter professional practice, they need additional assistance as they began their transition. The NRP has been helpful in providing new graduate nurses with the knowledge and skills needed for success in the fast paced healthcare environment. Further, the NRP provides support to cope with the changes in the healthcare environment. While NRPs are resource intensive, in the end, they reduce graduate nurse turnover rates.

References
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